Radiological Markers of the Olfactory Cleft: Relations to Unilateral Orthonasal and Retronasal Olfactory Function

The opacification of the olfactory cleft (OC) has been associated with birhinal orthonasal olfaction in patients with chronic rhinosinusitis (CRS). The aim of this study was to determine the associations between monorhinal and birhinal orthonasal, and retronasal olfaction with radiological markers of the OC in a cohort of patients with CRS. Results were analyzed in a CRS-cohort including 13 patients with nasal polyposis (CRSwNP) and 12 patients with non-eosinophilic CRS (non-eCRS). Monorhinal and birhinal orthonasal olfactory function, and OC-air volume were higher in non-eCRS compared CRSwNP. OC-opacification was also higher in CRSwNP compared to non-eCRS. In the entire CRS-cohort, those with higher OC-opacification showed significantly lower orthonasal and retronasal olfactory test results compared to those with lower OC-opacification across all three coronal planes. Similarly, higher unilateral OC-opacification was also associated with lower ipsilateral orthonasal olfactory function. Correlation analysis further revealed a positive correlation between monorhinal and birhinal orthonasal olfaction with ipsilateral and overall OC-air volume. Likewise, birhinal and monorhinal orthonasal, and retronasal olfactory test results correlated negatively with the overall and ipsilateral Lund-Mackay scores. Monorhinal and birhinal orthonasal, and retronasal olfactory function were lower in CRS patients with higher ipsilateral and overall OC-opacification compared to those with lower OC-opacification

Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography

Objectives: To assess the performance of the “Computer-Aided Nodule Assessment and Risk Yield” (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). Methods: 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. Results: 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001–0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). Conclusions: CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. Key points • CANARY-based risk assessment allows the differentiation of their histological subtypes. • 45% or less of low-risk component reflects histological invasiveness. • CANARY has potential role in suspected adenocarcinomas manifesting as pure ground-glass nodules. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-4937-2) contains supplementary material, which is available to authorized users

Beurteilung des vertebralen Knochenmarks und der Wirbelkörperendplatte mittels MRT-Bildgebung zur Differenzierung von Modic Typ 1 Endplattenveränderungen und infektiöser Spondylodiszitis

Grundlage der Arbeit war die Bildgebung der Wirbelkörperendplatten, des vertebralen Knochenmarks und der Bandscheiben mittels Magnetresonanztomographie (MRT). Basierend auf retrospektiven Datenanalysen wurden drei spezifische Fragestellungen thematisiert. Die erste Studie befasste sich mit dem klinischen Problem der Unterscheidung zwischen Wirbelsäulendegeneration und -infektion. In der MRT weisen Modic Typ 1- (MoT1) Degeneration und Spondylodiszitis überlappende Veränderungen wie Knochenmarködeme und Endplattenveränderungen auf. Hinsichtlich der Differenzierungsmöglichkeit untersuchte diese Studie Veränderungen des vertebralen Knochenmarks und der Endplatten, anhand von spinalen MRT-Untersuchungen bei Patienten mit MoT1-Veränderungen, früher Spondylodiszitis ohne Abszess und fortgeschrittener Spondylodiszitis mit Abszess. Das durchschnittliche Ausmaß des Knochenmarködems zeigte zwischen MoT1-Veränderungen, früher Spondylodiszitis und fortgeschrittener Spondylodiszitis signifikante Unterschiede (p < 0.001). Um MoT1-Veränderungen zu identifizieren, zeigte das Merkmal einer unregelmäßigen, aber noch intakten Endplatte die höchste diagnostische Genauigkeit (Sensitivität, 95%; Spezifität, 94%), was insbesondere zur Differenzierung der Spondylodiszitis im Frühstadium nützlich war. Die zweite Studie schlug den Bogen von Knochenmarködem zum häufigen zufälligen, aber unspezifischen MRT-Befund eines Ödems lumbal im posterioren tiefen subkutanen Gewebe. Dies wurde bei Patienten mit lumbaler geringer Bandscheibendegeneration, fortgeschrittener Wirbelsäulendegeneration, axialer Spondylarthropathie und infektiöser Spondylodiszitis untersucht, bei denen jedoch keine Herz-Kreislauf-, Nieren- oder Lebererkrankung bestand. Dieses Ödem trat am häufigsten bei Spondylodiszitis (61%) und insbesondere bei adipösen Patienten (72%) auf. Die perifasziale Lage des Ödems deutet auf einen möglichen faszialen Ursprung hin, dies muss von einem posttraumatischen oder infektiösen Ödem oder einem Ödem im Rahmen einer internistischen Erkrankung unterschieden werden. Die dritte Studie befasste sich mit geschlechtsspezifischen Aspekten der Bandscheibendegeneration bei 943 jungen Frauen. Basierend auf pränatalen MRT-Untersuchungen, die zur Beurteilung des Fetus dienen, untersuchte diese Studie inzidentelle Bandscheibendegenerationen und -herniationen bei jungen, schwangeren Frauen. Bei allen Frauen war die Bandscheibendegeneration ein ubiquitärer, inzidenteller Befund, mit Zunahme ab der späten zweiten Lebensdekade, wahrscheinlich teilweise im Rahmen der physiologischen Alterung. Im Gegensatz dazu bestand nur ein kleiner Prozentsatz (6%) an inzidentellen Bandscheibenherniationen.The foundation of the current thesis was the investigation of the vertebral endplate and bone marrow, as well as the intervertebral disc, on magnetic resonance imaging (MRI). Three specific topics were covered based upon retrospective data evaluation. The first study dealt with the clinical problem in differentiating spinal degeneration from infection. On MRI, Modic type 1 (MoT1) endplate degeneration and spondylodiscitis share overlapping findings, such as bone marrow edema (BME) and endplate alterations. Therefore, for differentiation, this study evaluated changes of the vertebral bone marrow and endplates based on spinal MRI examinations of patients with MoT1 changes, early stage spondylodiscitis (no abscess), and advanced stage spondylodiscitis (present abscess). Between those three conditions, the mean BME extent was significantly different (p < 0.001). To identify MoT1, a present irregular, still-intact endplate revealed the highest diagnostic accuracy (sensitivity, 95%; specificity, 94%), which was useful for differentiating spondylodiscitis, particularly at an early stage. From BME to soft tissue edema, the second study drew attention to the frequent incidental, non-specific MRI finding of deep subcutaneous edema at the lumbar spine. This was investigated in patients with lumbar spine abnormalities, such as low-grade degeneration of the discs, advanced degeneration (osteochondrosis intervertebralis), immune-mediated spondyloarthritis, and spondylodiscitis, but without functional disorders of the heart, kidneys, and liver. This edema most commonly occurred in spondylodiscitis (61%), and particularly in obese patients (72%). The perifascial extension of edema might suggest an underlying fascial disorder, which is different from posttraumatic, or infectious edema, or edema resulting from internal diseases. The third study sought to address a special gender aspect of degeneration of the intervertebral discs. Based upon prenatal MRI, applied for assessment of the fetus, this study aimed to evaluate incidental degeneration and displacement of the lumbar discs in 943 young, pregnant women. As all women were affected by degeneration of the lumbar discs, this was a ubiquitous MRI finding, from 18 years of age onward, likely as part of the physiological aging process. In contrast, disc displacement was infrequently observed (6%).Abweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedizinische Universität Wien, Diss., 202